Failure to Provide Nutritionally Equivalent Alternate Meal Options
Penalty
Summary
The facility failed to provide alternative meal options with equivalent protein and calorie content to the main entrée when residents selected alternatives such as grilled cheese sandwiches or cheese quesadillas. During meal service observations, these alternatives were prepared with significantly less protein—approximately 9 to 15 grams—compared to the 21 grams provided in the main entrée. The grilled cheese sandwich consisted of two slices of bread and one slice of cheese, while the quesadilla was made with two corn tortillas and one-fourth cup of shredded cheese. These alternatives were chosen by residents, including one who requested no pork or chicken. Interviews with the Registered Dietician confirmed that alternate meals should match the protein content of the main entrée, and the Dietary Supervisor acknowledged that additional items like yogurt, soup, cottage cheese, or beans could be added to increase nutritional value, but these were not provided at the time. Review of the facility's menu policy indicated that missing food groups should be supplemented to meet residents' nutritional needs, but this was not consistently implemented during the observed meal services.